Many people have found themselves in need of a psychologist, therapist, or addiction specialist, but have struggled to find one that is covered by insurance.
But despite a seemingly vast directory of some insurance plans, the calls end up being frustrating, one after the other. Perhaps the doctor isn't accepting new patients, the phone number is inaccurate or disconnected, or the doctor may have terminated your insurance long ago. Maybe there aren't even doctors.
This phenomenon has a name: “ghost networks.”
And a new class action lawsuit alleges that New York's Anthem Blue Cross Blue Shield maintains a ghost network, which patient lawyers call “stunning.” is.
“Many people experience such issues and don't talk about it, because mental health care is Because it's not something people want to talk about.” The law firm that filed the lawsuit.
Lawyers for the plaintiffs, who asked not to be named to protect their privacy, said the case mirrored the experience of patients searching for mental health providers through their insurance companies' directories. They called the first 100 providers listed in Anthem's directory, but were able to get an appointment with only seven. Some hospitals no longer accepted insurance, others had the wrong specialty or the wrong phone number, or weren't accepting patients in the next six months.
The alleged “ghost network” in the new lawsuit occurred in a program for members of the Federal Employees Health Benefits System. Lawyers said the insurance company ran a “deceptive advertising campaign aimed at directing people to the insurance plan.”
The lawsuit comes at a time when experts say the United States is in the midst of a mental health crisis. A recent report by the Pew Charitable Trusts argues that this crisis is actually three crises at once. One is the mental health crisis among young people, with reported increases in depression and suicide; the other is the drug use crisis, where overdose deaths are common; and the other is the serious mental illness crisis that causes homelessness. and imprisonment.
The lawsuit's findings join those conducted by academics, the U.S. Senate Finance Committee, and the U.S. Government Accountability Office, which found that the majority of mental health providers in the insurance networks studied were not filling appointments. It turned out.
“These are deceptive business practices, and these insurance companies should be held accountable in court,” Democratic Sen. Tina Smith of Minnesota said. Smith introduced a bill that would impose fines on insurance companies for inaccurate rosters, among other provisions.
Mr Smith said insurers were “not following the letter and spirit of the Mental Health Equality Act”, which requires businesses to cover mental health to the same extent as they cover physical health. Additionally, the No Surpris Act requires insurers to review their provider networks every 90 days and pay any bills they receive as a result of an inaccurate listing as if they were in-network. .
“It's a little sad to think that we have to enact a law that says, 'This must be done, and there will be penalties if you don't comply,' but I think that's an important step that we need to take.” said Smith.
The U.S. Senate Finance Committee investigated ghost networks in Medicare Advantage plans, the private insurance available to Medicare beneficiaries and the public health insurance program for elderly and disabled Americans. The plan has been widely scrutinized as an unscrupulous business practice. More than 80% of providers are “ghosts” – unreachable, out of network, or unable to schedule an appointment.
In a 2020 study, Louisiana academics looked at issues with Medicaid, the public insurance program for low-income and disabled people. Only 25% of more than 2,600 providers were accepting new patients. A 2017 study focused on psychiatrists who treated children and adolescents in five U.S. cities, but only 17% of the providers on the list were able to get an appointment. A 2015 study of three U.S. cities found that 22% of adult psychiatrists' phone numbers were incorrect and 21% were not accepting new patients.
“We are facing a mental health crisis and we need to strengthen our health care plans,” said Sue Abderholden, executive director of NAMI Minnesota National Alliance on Mental Illness. She said the problem with ghost networks is partly a workforce issue.
A recent ProPublica study found that for many mental health providers, joining an insurance network simply isn't worth it. Low wages and insurance contracts, including clawback clauses that allow insurers to put money directly into bank accounts, make it impossible to stay in-network.
“As a result, fewer practitioners accept insurance, which of course impacts patient access,” said London Breedlove, a licensed psychologist and professional director of the Washington State Psychological Association.
“But as a consumer, you don't necessarily know that. If you're on a private health plan and you go to your insurance website and say, 'I want a provider,' and enter your zip code. , it looks like there are a lot of people accepting patients.”
More than half of Americans live in areas with a shortage of mental health care providers, and this problem is expected to worsen by 2036.
“We are seeing a significantly higher percentage of patients in our state who must go out of network to access critical mental health resources,” Breedlove said.
For health care providers that accept insurance, mental health providers are typically paid only $0.76 for every dollar paid to primary care providers covering physical health.
Breedlove is sponsoring a bill in Washington state that would index mental health care reimbursement rates to inflation. She hopes this cost-of-living adjustment will make insurance more attractive to her colleagues.
“If you don't have enough people in your network to build a good network, you have to pay more money to hire people,” Abderholden said. “Once that starts happening, it's going to improve access because people won't have to leave the field. You're going to have people making enough money to cover their student loans.”
